Abstract
BackgroundTransient Ischaemic Attack (TIA) requires urgent investigation and management. Urgent management reduces the risk of subsequent stroke markedly, but non-presentation or delays in patient presentation to health services have been found to compromise timely management. We aimed to explore general practice patients’ anticipated responses to TIA symptoms.MethodsThis was a qualitative study employing semi-structured telephone interviews. Participants were recruited from respondents in an earlier quantitative study based in Australian general practices. Maximum variation purposive sampling of patients from that study (on the basis of age, rurality, gender and previous experience of stroke/TIA) continued until thematic saturation was achieved. After initial interviews explored knowledge of TIA and potential responses, subsequent interviews further explored anticipated responses via clinical vignettes containing TIA and non-TIA symptoms. Transcribed interviews were coded independently by two researchers. Data collection and analysis were concurrent and cumulative, using a process of iterative thematic analysis and constant comparison. A schema explaining participants’ anticipated actions emerged during this process and was iteratively tested in later interviews.ResultsThirty-seven interviews were conducted and a ‘spectrum of action’, from watchful waiting (only responding if symptoms recurred) to summoning an ambulance immediately, was established. Intermediate actions upon the spectrum were: intending to mention the episode to a general practitioner (GP) at a routine appointment; consulting a GP non-urgently; consulting a general practitioner (GP) urgently; and attending an Emergency Department urgently. The substrate for decision-making relating to this spectrum operated via three constructs: the ‘individual set’ of the participant (their inherent disposition towards action in response to health matters in general), their ‘discriminatory power’ (the ability to discriminate TIA symptoms from non-TIA symptoms) and their ‘effective access’ to health-care services.ConclusionsPolicies to improve patients’ accessing care (and accessing care urgently) post-TIA should address these three determinants of anticipated action.
Highlights
Transient Ischaemic Attack (TIA) requires urgent investigation and management
The demographics of the participants are presented in Additional file 1: Table S1
Spectrum of anticipated action The overarching finding was of a ‘spectrum of anticipated action’ in the event of TIA symptoms
Summary
Transient Ischaemic Attack (TIA) requires urgent investigation and management. Urgent management reduces the risk of subsequent stroke markedly, but non-presentation or delays in patient presentation to health services have been found to compromise timely management. Transient ischemic attack (TIA) can confer a high risk of stroke immediately post-event with an average 11·0% risk during the first 7 days [1]. Urgent preventative treatment post-TIA can confer marked risk reduction, [3,4,5] current Australian guidelines [6] recommend urgent investigation and initial treatment of TIA, ideally within 24 h of the initial event. Assessment delay post-TIA is more often due to patient delay than to health services delay [7]. The majority of patients with TIA present to GPs rather than Emergency Departments (EDs) [9]. Longer duration of symptoms, and higher risk TIAs are associated with less delay [8,9,10] as are purely visual symptoms, [10] but correct recognition of symptoms has been inconsistently associated with delay [8, 9]
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